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Published on: October 19, 2013
Clinical phenotype of pulmonary vascular disease requiring treatment in extremely preterm infants
Ki Teak Hong1, Seung Han Shin1,2, Ee-Kyung Kim1,2
1Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
Insights
Pulmonary hypertension (PH) treatment timing in extremely preterm infants impacts outcomes. Early treatment may increase mortality but shorten respiratory support, while late treatment prolongs it.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Pulmonary vascular disease and pulmonary hypertension (PH) significantly impact extremely preterm infants' prognosis.
- Lack of consensus exists on PH definition and optimal treatments in this population.
- Research comparing PH timing (PPHN, early, late) in extremely preterm infants is limited.
Purpose of the Study:
- To investigate PH in extremely preterm infants by comparing outcomes based on treatment timing.
- To analyze baseline characteristics, short-term outcomes, and treatment duration across different PH treatment initiation periods.
Main Methods:
- Retrospective analysis of extremely preterm infants (2018-2022) requiring PH treatment.
- Categorization into three groups: extremely early (first 3 days), early (days 4-27), and late (after day 28) treatment initiation.
- Comparison of mortality, bronchopulmonary dysplasia (BPD) severity, and treatment durations.
Main Results:
- Of 157 infants, 67 (42.7%) received PH treatment: 39 extremely early, 21 early, 7 late.
- No significant differences in maternal/neonatal factors or morbidity.
- Extremely early treatment associated with higher mortality but shorter respiratory support, oxygen, and PH medication duration. Late treatment group had longer support/treatment durations.
Conclusions:
- Timing of PH treatment initiation in extremely preterm infants influences mortality and respiratory outcomes.
- Differences suggest evolving pathophysiologies of PH in this vulnerable population over time.
- Further research is needed to refine treatment strategies based on PH timing.
Background:
Pulmonary vascular disease (PVD) and pulmonary hypertension (PH) is a significant disorder affecting prognosis of extremely preterm infants. However, there is still a lack of a consensus on the definition and optimal treatments of PH, and there is also a lack of research comparing these conditions with persistent pulmonary hypertension of newborn (PPHN), early PH, and late PH. To investigate PH in extremely preterm infants, this study compared the baseline characteristics, short-term outcomes, and treatment duration, categorized by the timing of requiring PH treatment.
Methods:
This study retrospectively analyzed extremely preterm infants admitted to a single tertiary center. Between 2018 and 2022, infants with clinical or echocardiographic diagnosis of PH who required treatment were divided into three groups based on the timing of treatment initiation: initial 3 days (extremely early-period), from day 4 to day 27 (early-period), and after day 28 (late-period). The study compared the outcomes, including mortality rates, bronchopulmonary dysplasia (BPD) severity, PH treatment duration, and oxygen therapy duration, among the three groups.
Results:
Among the 157 infants, 67 (42.7%) were treated for PH during their stay. Of these, 39 (57.3%) were treatment in extremely early, 21 (31.3%) in early, and seven (11.4%) in late periods. No significant differences were observed in maternal factors, neonatal factors, or morbidity between the three groups. However, infants who received extremely early-period treatment had a higher mortality rate, but shorter duration of noninvasive respiratory support, oxygen therapy, and PH medication use. On the other hand, the late-period treatment group received longer durations of respiratory support and treatment.
Conclusions:
This study revealed differences in mortality rates, respiratory outcomes, and treatment duration between the three groups, suggesting varying pathophysiologies over time in extremely preterm infants.
